Enhancing midwives' occupational well-being: Lessons from New Zealand's COVID-19 experience.

BACKGROUND: The World Health Organization posits that adequate maternity health is possible if midwives are supported, respected, protected, motivated, and equipped to work safely and optimally within interdisciplinary health care teams. Based on qualitative survey data, we argue that the COVID-19 pandemic amplified job demands and resources, professional invisibility, and gender norms to negatively impact midwives' well-being. PURPOSES: We aim to develop a refined understanding of the antecedents of well-being in midwifery to equip policymakers, administrators, and professional associations with the knowledge to enhance midwives' well-being postpandemic. METHODOLOGY/APPROACH: Drawing on the Job Demands-Resources model, we thematically analyzed qualitative survey data ( N = 215) from New Zealand midwives to reveal how job demands, resources, and structural factors impacted midwives' well-being. RESULTS: We identified fear of contracting and spreading COVID-19, financial and legal imperatives (job demands), work-related hypervigilance, sense of professional duty, practical and social support, and appreciation and recognition (job resources) as key antecedents of midwives' well-being. These job demands and resources were influenced by professional invisibility and gender norms. CONCLUSION: Policy and practice solutions must address job demands, resources, and structural factors to meaningfully enhance midwives' well-being postpandemic. PRACTICE IMPLICATIONS: We recommend that policymakers, administrators, and professional associations monitor for signs of overcommitment and perfectionistic strivings and then take appropriate remedial action. We also suggest that midwives receive equitable pay, sick leave, and other related benefits.

Gaining insight from future mothers: A survey of attitudes and perspectives of childbirth.

OBJECTIVE: To determine whether participant characteristics and/or birth preferences of future mothers are associated with a fear of birth. DESIGN: A cross-sectional survey was used to determine if fear of birth could be profiled in specific participant characteristics and birth choices. SETTING: Urban New Zealand university. PARTICIPANTS: A convenience sample of women (final n = 339) who were < 40 years old, attending university, not pregnant nor had been pregnant but wished for at least one child in the future. FINDINGS: Multivariable analysis identified a subset of four variables that were independently associated with the instrument Childbirth Fear Prior to Pregnancy (CFPP) measuring fear of birth (mean CFPP=38.0, SE=10.1). Preferences of birth by caesarean section (n=32, mean CFPP=44.3, SE=1.8, p < 0.0001), use of epidural analgesia (n=255, mean CFPP=45.0, SE=1.1, p < 0.0001), participants born outside of New Zealand (n=123, mean CFPP=42.9, SE=1.4, p < 0.0001), and participants who scored > 20 ('severe') for depression on DASS-21 scale (n=11, mean CFPP=44.8, SE=1.7, p < 0.0001) were all positively associated with CFPP. Post-hoc analyses revealed that mean CFPP was higher for those that perceived birth technologies as easier, safer, necessary, and required. CONCLUSIONS: Women born outside of New Zealand and/or suffering 'severe' depression were more likely to have a fear of birth. Fear of birth was associated with the participants choices towards medicalised childbirth. Familiarising women with the provision of maternity care in New Zealand and identifying mental health status early could reduce fear of birth and possibly support the vaginal birth intentions of future parents.

Drivers of job satisfaction in midwifery-A work design approach.

BACKGROUND: Identifying common factors that influence job satisfaction for midwives working in diverse work settings is challenging. Applying a work design model developed in organisational behaviour to the midwifery context may help identify key antecedents of midwives job satisfaction. AIM: To investigate three job characteristics - decision-making autonomy, empowerment, and professional recognition as antecedents of job satisfaction in New Zealand (NZ) midwives. METHODS: Latent multiple regressions were performed on data from Lead Maternity Carer (LMC) midwives n = 327, employed midwives n = 255, and midwives working in 'mixed-roles' n = 123. FINDINGS: We found that professional recognition is positively linked to job satisfaction for midwives in all three work settings. At the same time, decision-making autonomy and empowerment were shown to influence job satisfaction for midwives working as LMCs only. DISCUSSION: Our main finding suggests that the esteem generated from being acknowledged as an expert and valuable contributor by maternity health colleagues is satisfying across all work contexts. Professional recognition encompasses the social dimension of midwifery work and influences midwives job satisfaction. Decision-making autonomy and empowerment are task and relational job characteristics that may not be similarly experienced by all midwives to noticeably influence job satisfaction. CONCLUSION: Given that job satisfaction contributes to recruitment, retention, and sustainability, our findings show that drivers of job satisfaction differ by midwifery work context. We present evidence to support tailored efforts to bolster midwives job satisfaction, especially where resources are limited.

Midwifery Job Autonomy in New Zealand: I do it all the time.

INTRODUCTION: This research aimed to identify what supports and what hinders job autonomy for midwives in New Zealand. METHODS: Registered midwives participated in an open-ended, online survey in 2019. Anonymised participants were asked to describe an incident when they felt they were using their professional judgement and/or initiative to make decisions and the resultant actions. The data was analysed thematically. FINDINGS: The participants identified that autonomy is embedded within midwifery practice in New Zealand. Self-employed midwives who provide continuity of care as Lead Maternity Carers, identified they practice autonomously 'all the time'. The relationship with women and their family, and informed decision making, motivated the midwife to advocate for the woman - regardless of the midwife's work setting. Midwifery expertise, skills, and knowledge were intrinsic to autonomy. Collegial relationships could support or hinder the midwives' autonomy while a negative hospital work culture could hinder job autonomy. DISCUSSION: Midwives identified that autonomous practice is embedded in their day to day work. It strengthens and is strengthened by their relationships with the woman/whanau and when their body of knowledge is acknowledged by their colleagues. Job autonomy was described when midwifery decisions were challenged by health professionals in hospital settings and these challenges could be viewed as obstructing job autonomy. CONCLUSION: The high job autonomy that New Zealand midwives enjoy is supported by their expertise, the women and colleagues that understand and respect their scope of practice. When their autonomy is hindered by institutional culture and professional differences provision of woman-centred care can suffer.

2,3,7,8-TCDD equivalence and mutagenic activity associated with PM10 from three urban locations in New Zealand.

Ambient particulate matter (PM(10)) in urban centres varies depending on emission sources, geography, demography, and meteorology. Hence physical (PM(10), wind speed, rainfall, temperature), chemical (polycyclic aromatic hydrocarbons, PAH), and toxicological (Ames Test, H4IIE EROD Assay) analyses were done on daily PM(10) (approximately 1640 m(3)/day) collected from three New Zealand urban sites where winter emissions were predominantly due to domestic home heating. Daily PM(10) levels ranged between 9.7 and 20.8 in summer and between 21.8 and 61.0 microg/m(3) in winter. Daily PAH concentrations were 0.5, 0.45, and 1.5 ng/m(3) in summer and 52.1, 128.9, and 5.8 ng/m(3) in winter at sites Christchurch, Alexandra and Dunedin, respectively. During winter, 74% of PM(10) extracts from all three sites showed significant mutagenicity in the Ames Test (TA 98, -S9), whereas approximately 25% of the daily PM(10) was mutagenic in summer. Benzo[a]pyrene and BaP carcinogenic equivalence concentrations during winter were strongly correlated to both mutagenicity and TCDD-like activity at two sites. Daily levels of TCDD toxicity equivalence concentrations ranged from 0.5 to 3.6 pg TCDD/m(3) air in summer and from 0.3 to 4009 pg TCDD/m(3) air in winter. Chemically and biologically derived TCDD toxicity equivalent concentrations were significantly correlated in all study locations indicating that PAH may represent most of the TCDD-like activity present in the PM(10).